The fate of the state's abortion clinics may hinge on two questions: Can physicians at those clinics obtain admitting privileges at local hospitals, and if they can't, would the closing of those clinics put a substantial burden on abortion rights?

As testimony Monday on the first day of a federal trial indicated, the respective answers of the state and the clinics involved are miles apart.

Clinic operators, who are suing to stop a 2013 law requiring every physician at an abortion clinic to have admitting privileges at a local hospital, cited a number of reasons why they could not meet the admitting privileges requirement.

Some of the doctors working at the three clinics involved in the lawsuit are not trained in the specialties required under the law. June Ayres, owner and director of Montgomery-based Reproductive Health Services, one of the plaintiffs, said the relative safety of abortion procedures meant that doctors would not be able to meet the patient volume most hospitals require to grant admitting privileges.

"Complications (from abortions) are rare to begin with, but any complication is usually resolved at a clinic before the patient leaves," Ayres said.

However, much of the argument before U.S. District Judge Myron Thompson Monday centered on the ability of clinics to find physicians in their local areas to perform the procedures. Both Ayres and Staci Fox, CEO of Planned Parenthood Southeast, which runs clinics in Birmingham and Mobile, said that local hostility to the services they provide made it virtually impossible to hire doctors from the local community. In 36 years at Reproductive Health Services, Ayres said she had never been able to hire a local physician to work at her clinic.

Ayres also said harassment made it difficult to hold onto the doctors the clinic currently has. One former physician at the clinic, referred to in testimony as Dr. D, once discovered that her personal information had been posted on an anti-abortion website.

"Dr. D. began to show us she was very nervous about coming into the clinic and leaving the clinic," Ayres said during two hours on the witness stand. "She would take her (ID) tag off three blocks from the clinic . . we made arrangements 10 minutes before she came in to get an officer to take her to the clinic."

Critics of the admitting privileges requirement have said it is medically unnecessary and would force the plaintiffs' clinics to close. Supporters of the law said it would guarantee women's health and safety and provide a continuum of care.

Attorneys with the Alabama Attorney General's Office questioned whether the clinics were doing everything possible to find physicians who could meet the requirements. Margaret Fleming, an attorney with the AG's office, noted that Ayres and other clinic operators had managed to comply with prior requirements from the state, such as a regulation requiring clinics to have contracts with back-up physicians to respond to emergencies. Ayres and Fox both testified that the physicians who perform abortions at the clinics live out of state, perform procedures once a week and spend between four and 10 hours at their clinics on the days they perform the procedures.

Fleming asked Ayres if she had offered financial incentives or contacted hospitals to see if arrangements could be made to accommodate their physicians. Ayres testified that she had obtained one application from a local hospital, but said the requirements for physicians to live in town made it impossible for her physicians to meet the requirements.

"We didn't pursue the application because on the face value of the application, we could not meet those requirements," Ayres said.

Reproductive Health Services' license was briefly suspended in 2006 over an allegation that the clinic did not have a back-up physician available to deal with a patient who had been admitted to a local emergency room. Ayres testified that the clinic had had back-up physicians for years, but signed a contract with the doctor involved following the incident.

Fox said in her testimony that Planned Parenthood had left "no stone unturned" in trying to find physicians who could meet the requirements at their clinics. However, she said that one physician feared that a rejected or withdrawn application for admitting privileges would affect their careers for the worse.

"I wasn't prepared to put her in a place to damage her career," Fox said.

The court also heard testimony from Sheila Katz, a sociologist soon to be based at the University of Houston, who analyzed the effect of closing the affected clinics. Citing statistics showing 42 percent of women who seek abortions live below the federal poverty line, Katz also presented an analysis showing that closing the clinics in Montgomery, Birmingham and Mobile would force women to spend additional money on gas, hotels, child care and other forms of transportation.

According to Katz, women traveling from Montgomery to Tuscaloosa for a procedure would spend $415 on travel and lodging costs, not connected to the procedure. The travel costs from Mobile would be even higher: Katz estimated those at $651.

"These costs are incredibly burdensome," she said. "These costs are more than what many women make in a week, and more than what some make in month."

Attorneys from the Attorney General's Office questioned the analysis, noting that women in Mobile could travel to a clinic in Pensacola, while women in Montgomery could go to a clinic in Columbus, Ga. Katz stood by the analysis, saying Alabama "was passing a tax on abortion, and this tax is most burdensome on low-income women."